Why pay for physical therapy services using cash rather than insurance?
You work hard for your money and you’re already paying for health insurance. Why shouldn’t you use that? The main point is that the value of care received through cash-based models are generally much higher through patient-centered care rather than being dictated by the terms of your insurance coverage. What is your health worth to you?
History Lesson
We didn’t always have insurance for health care. In 1900, the average American spent $5 a year on health care so there was no need for something like insurance. Each practitioner had a fee for service model. In the 1920’s one official at Baylor University Hospital in Dallas noticed that people spent more on cosmetics than on medical care. Officials wanted to get people to buy in more on services so they decided to try letting people pay for their health care services a little bit each month and Baylor would pick up tabs on future hospital visits. The first test run was with a group of public school teachers in Dallas—it didn’t go so well. The idea didn’t really become popular until the great depression hit, when the plan took off and eventually became known as Blue Cross.
Modern Time
Fast forward to 2017, the American healthcare system for rehabilitation is broken. Reimbursements for the same services that may have been provided 10 years ago have now dramatically decreased. What does this have to do with you?
Well, now that same physical therapy practice or any other medical practice (because don’t forget your doctor is also influenced by insurance rates) needs to increase the volume of patients that they see so that they can keep their lights on. This essentially means that practitioners need to either increase their work hours to see more patients and/or find ways to see more patients at the same time. Co-pays and deductibles continue to rise as well, and ultimately as a patient, you are spending more money for LESS time with your healthcare professional. That’s not a very good deal if you think about it.
Real Life Example
In addition to seeing patients at Cozy Physical Therapy, I am also moonlighting at another clinic that allows me to see one patient at a time. However, my treatment can be limited by insurance company policies. I am able to spend 30 minutes to 1 hour with my patients but sometimes, this time may only be authorized for certain procedures such as massage or therapeutic exercise as standalone treatments. This could present a bias on my treatment focus. Do I run the risk of providing what I think would be the most optimal care and not get paid for my services or time? How long could I do this before I run the company into the ground from being denied by insurance reimbursement?
What I just described is already pretty incredible compared to other physical therapy clinics that have to push clinicians to see 4-6 patients an hour simply because reimbursement rates from insurance companies are so low that they have to supplement quality care with quantity. You may have been to a place similar to what I described and I’m happy to present you an alternative.
Some places may do very well operating that way and some patients will eventually get better, as most people do with the natural course of time. But realistically, how much time do you think you are spending with someone truly qualified to help your situation?
Now the real grits of the matter…think about how much your co-pay might be, possibly ($20-40)? If you are placed on a plan of care of 2-3 x a week for 6-8 weeks (because there just isn’t enough 1 on 1 instruction time for you to be able to fully grasp what you need to do to be successful), that’s $480-960 (assuming 24 sessions) on just your co-pays alone. What if you haven’t met your deductible?
I don’t know about you but that is a lot of uncertainties, and if I am paying for a service (in both my time and money) I expect there to be some favorable outcome.
Compare and Contrast
Let’s compare this to the “Cash Pay Model” I am proposing, where each person will receive 1-on-1 treatments from a doctor of physical therapy for the full session of 60-90 minutes. Comparatively, a traditional outpatient physical therapy clinic may have you work with an aide or assistant which may utilize treatment interventions such as putting heat + ultrasound on you for 30 minutes. Eventually a therapist will follow up with you for 10 minutes then you’re back to the aide for more work. The amount of personal attention and detail that can go into your plan of care is vastly different with the “Cash Pay Model” which leads to faster, more positive outcomes with less time. Instead of typical plan of cares of twice a week, people can be seen once a week or even every other week. The amount of time you would save by not attending therapy sessions regularly could be spent doing activities you enjoy. After all, isn’t that reason why you are going to therapy in the first place? To be able to do more of the things you can’t do, with the people you care about?
There is, of course, a scary side to having more freedom and less visits; it means more ownership of your own health. This makes the therapist more of a guide; someone to help lead you in the right direction, ultimately empowering you with the tools to be successful. Could it be possible that you learn some new tricks/concepts to help manage your symptoms? What if now down the line something else unexpectedly happens to you, could you use those tricks to help manage your symptoms? I hope so. Now what if you had been on ultrasound and heat the entire time? You’d be reliant on those passive modalities for that quick fix and probably be waiting to get another appointment in to see your doctor for some medication/injection. (I hope this won’t be your case).
Individuals that pay for physical therapy out-of-pocket aren’t necessarily rich and wealthy. People pay for these services because they perceive a higher value. Relate this to other health services people might pay for. Massage therapy can be around $60-120 and personal training sessions can be around $100-200. Comparably, most physical therapists have an extensive education on musculoskeletal injuries, how to optimize health and movement, all while helping to reduce pain and return you to your normal activities. Not to mention, they also have hands on skills to help change the perception of your symptoms. What would you pay to improve your quality of life and to get back to the things you love?
Final Points
People are more likely to succeed with physical therapy treatments if they have an investment into their own health. Learning and growth occur when problems are solved with guidance and concepts rather than being spoon-fed answers. There is no magic pill to help solve all your problems (yet), until that day comes, I will continue to provide the quality care necessary to help you get back to your activities and to reach your goals. If you would like more information, don’t hesitate to contact us.